Camp Dates: June 9th - June 13th 2025

Camp Dates: June 9th - June 13th 2025
Child/Athlete Information
Child/Athlete's Name*

First NameLast Name
MaleFemale
Grade*
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
T-Shirt Size*
Skill Level*
Parent/Guardian Information
Parent/Guardian's Name*

First NameLast Name
Parent/Guardian's Home Number
Format: (000) 000-0000.
Parent/Guardian's Cell Number*
Format: (000) 000-0000.
Parent/Guardian's E-mail*
example@example.com
Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact's Phone Number*
Format: (000) 000-0000.
Emergency Contact's Alternative Phone Number
Format: (000) 000-0000.
Does the child/athlete have any allergies, chronic illness, or medical conditions you would like the staff to be aware of. *
If yes, please describe below or provide written documentation to staff prior to the start of the camp.
Amplifying Information (If Desired)
Informed Consent and Acknowledgement

I hereby certify my child/athlete is in good health and I give my approval for him/her to participate in any and all activities prepared by this organization, during the selected camp being held at Stafford County High School. I fully understand the risk of injury that is inherent in all sports activities, including basketball. Some of these injuries include but are not limited to, the risk of fractures, paralysis, or death. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Stafford County, Stafford High School and all its respective officers, agents, representative/volunteer coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event from any and all liability of injuries to my child/athlete arising out of participating in this camp. In the event my child/athelte requires immediate medical attention, I authorize and give concent to the camp staff to provide/seek emergency medical care.
Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
E-Signature*
Yes, I would like to sponsor an athleteNo, not at this time
Pay NowPay Later

Registration Camp Fee

Non-refundable

$100.00

Sponsor an Athlete(s)

$100.00 Quantity

Service Fee

Service Fee (Non-refundable)

$3.20

Enter coupon

Total

$0.00

Should be Empty:

Camp Dates: June 9th - June 13th 2025

Child/Athlete Information

Parent/Guardian Information

Emergency Contact Information